Prevalence and cost of surgical treatment for female stress urinary incontinence in Brazil: A comparison between abdominal and vaginal approaches.

OBJECTIVE: Report the progress of the treatment of female stress urinary incontinence (SUI) in Brazil through vaginal and abdominal approaches and the direct costs by hospitalisation, using DATASUS-a public entity of the Strategic and Participative Management Secretary of Health Ministry, with the responsibility of collecting, processing, and disseminating public health information. DESIGN: Epidemiological study using the Brazilian Public Health Data Center System (DATASUS). PARTICIPANTS/MATERIALS, SETTING, AND METHODS: Data were collected on all hospital admissions associated with treatment from 2008 to 2019 from the DATASUS. We analysed the records of hospitalisations associated with an abdominal or vaginal surgical SUI treatment. RESULTS: The total number of procedures for the treatment of female SUI performed from 2008 to 2019 was 84.378, of which 70 238 were vaginal and 14 140 abdominal. There was an overall decrease in the number of SUI procedures in Brazil over the years analysed (F = 52.72; P < .0001); only exception was the South region (F = 1.38; P = .267). A declining trend was identified for the abdominal approach, with an increased trend of the vaginal approach (F = 170.11; P < .0001). A declining number of hospitalisation days was noted in the vaginal procedures (P = .002). Despite the fact that no differences were noted between abdominal and vaginal expenses (P = .054), hospital expenditure increased over the years for both vaginal and abdominal approaches, with no significant differences between either approaches. However, a statistically significant professional expenditure was observed in the abdominal approach (P < .001). Analysing hospitalisation and professional expenses, the total mean in the period was statistically higher for the abdominal approach (P < .0001). CONCLUSIONS: The number of procedures to treat female SUI in Brazil has decreased from 2008 to 2019. Total financial expenditure per procedure and length of hospital stay were both higher for the abdominal approach (Burch colposuspension). A preference for a vaginal approach (pubovaginal sling or midurethral sling) has increased significantly since 2008, and our study favours this approach.

Ultrasound-Guided Vascular Access Simulator for Medical Training: Proposal of a Simple, Economic and Effective Model.

OBJECTIVE: To present a simple and affordable model able to properly simulate an ultrasound-guided venous access. DESIGN: The simulation was made using a latex balloon tube filled with water and dye solution implanted in a thawed chicken breast with bones. RESULTS: The presented model allows the simulation of all implant stages of a central catheter. The obtained echogenicity is similar to that observed in human tissue, and the ultrasound identification of the tissues, balloon, needle, wire guide and catheter is feasible and reproducible. CONCLUSION: The proposed model is simple, economical, easy to manufacture and capable of realistically and effectively simulating an ultrasound-guided venous access.

Anosmia congênita associada à hipospádia: relato de caso / Congenital anosmia associated with hypospadia: a case report

Introdução: A incidência de distúrbios olfatórios nos Estados Unidos da América é de cerca de 200 mil pacientes por ano, sendo as doenças sinusais as causas mais comuns. A anosmia congênita é rara e pode ocorrer como parte de uma síndrome ou como anosmia isolada. O objetivo deste trabalho é relatar um caso raro de anosmia congênita associada à hipospádia. Descrição do caso: Paciente masculino com 20 anos de idade e quadro de anosmia congênita, apresentando gustação e sensibilidade olfatória para odores irritantes preservadas. Refere hipospádia operada aos 13 anos de idade. Negava antecedentes familiares de anosmia. Apresentava exame otorrinolaringológico e nasofibroscopia sem alterações. Ao exame neurológico constatou-se anosmia pelo Cross Culture Smell Test. Ao exame geniturinário, apresentava orifício fistuloso em face ventral de terço médio do pênis, testículos tópicos e de tamanho normal, e desenvolvimento normal dos caracteres sexuais secundários. Observou-se, na tomografia computadorizada dos seios paranasais, presença de concha média bolhosa à esquerda. A ressonância magnética apresentava-se dentro dos padrões de normalidade. Uma análise hormonal foi realizada, cujos resultados foram: hormônio luteinizante de 5,02 mUI/mL, Hormônio folículo-estimulante de 0,8 mUI/mL e testosterona total de 887 ng/dL. Discussão: O relato deste caso é importante pela existência de apenas dois casos relatados na literatura de anosmia congênita associada à hipospádia. O relato de um novo caso e da associação da anosmia com outras anormalidades, como a hipospádia, pode auxiliar na aquisição de novos conhecimentos sobre o assunto e a despertar interesse na descoberta de algum fator etiológico comum às duas anormalidades.

Introduction: The incidence of olfactory disorders in the United States is approximately 200,000 patients per year. Sinus diseases are the most common causes. The congenital anosmia is rare and may occur as part of a syndrome or isolated. The purpose of this paper is to report a case of congenital anosmia associated with hypospadia. Case report: Male, 20 years old, reporting congenital anosmia. The taste and olfactory perception for irritant odors were preserved. He was submitted to hypospadia repair surgery at the age of 13 years old. Family history of anosmia was negative. Otolaryngologyc exam and nasofibroscopy were normal. In the neurologic exam, anosmia was determined by Cross Culture Smell Test. Genitourinary exam showed: fistular orificium in ventral face of medium third section of penis, topic and normal size testicles and full development of secondary sexual characters. On computed tomography of paranasal sinuses, a concha bullosa was observed on the left. The magnetic resonance was normal. Hormonal tests: LH 5.02 mUI/mL, FSH 0.8 mUI/mL and total testosterone 887 ng/dL. Discussion: This case report is important because there are only two cases reported in the literature about congenital anosmia associated with hypospadia. The report of a new case and the association of anosmia with others abnormalities such as hypospadia may lead to additional knowledge about the subject and may raise interest on the discovery of common etiological factors of these abnormalities (anosmia and hypospadia).

Isolated anterior urethral trauma in man after coitus:a case report / Trauma isolado de uretra anterior masculina após coito: relato de caso

Penile fracture with or without urethral injury after coitus presents with severe pain and immediate penile detumescence accompanied by a cracking sound. Hematuria or voiding difficulty are common findings and suggest associated urethral injury. The objective of this report is to describe an unusual complication of coital trauma diagnosed based on clinical findings. The isolated urethral injury is rare but is one of the causes of male coital trauma and may be suspected when patients present urethral bleeding.

Fratura de pênis com ou sem lesão de uretra é a principal lesão ocorrida durante o ato sexual e se apresenta com dor intensa, rápido intumescimento e estalido. Hematúria ou dificuldade miccional são sintomas incomuns, que sugerem lesão de uretra associada. O objetivo do trabalho foi relatar essa rara complicação de lesão isolada de uretra durante o intercurso sexual cujo diagnóstico se acha baseado em achados clínicos. A lesão isolada de uretra, embora rara, pode ocorrer durante o intercurso sexual e deve ser suspeitada na presença de uretrorragia.

Female urethral diverticulum associated witha large urinary calculus / Divertículo de uretra feminina associado a grande cálculo urinário

The diverticula of female urethra are very uncommon, but more frequently found between the third and fifth decade of life. Diverticula area mostly relate to repeated urinary infections of the periurethral glands or urethras trauma. The diverticula may cause infection, calculus formation and rarely endometriosis or cancer. A case of a 65-year old Caucasian female with vaginal mass over six months is herein reported. There was no urinary loss, urethral secretion or urinary symptoms. A cystourethrography showed diverticula with calculus inside. The patient was submitted to surgery and dismissed from the hospital on the first postoperative day. The pathologic examination revealed no malignancy. In six months of follow-up, the patient was continent with no complaints.

Os divertículos de uretra feminina são incomuns, porém mais frequentes entre a terceira e a quinta década de vida. A maioria dos divertículos de uretra está relacionada a infecções recorrentes das glândulas periuretrais ou traumatismo uretral. Os divertículos podem ser sítio de infecções, formação de cálculos e, mais raramente, endometriose ou neoplasia. Relata-se o caso de paciente de 65 anos, branca, com queixa de nódulo em parede vaginal notado há seis meses. Negava incontinência urinária, derrame uretral e sintomas urinários de armazenamento ou de esvaziamento. A uretrocistografia miccional revelou divertículo uretral associado a cálculo. Submetida à cirurgia, teve alta hospitalar no primeiro dia pós-operatório. O resultado do exame anatomopatológico não evidenciou malignidade. Após seis meses de seguimento, a paciente encontra-se sem queixas urinárias ou vaginais e com continência urinária preservada.

What is the best choice for chronic urinary retention: indwelling catheter or clean intermittent catheterization? / Qual a melhor escolha para a retenção urinária crônica: sondagem vesical de demora ou cateterismo intermitente limpo?

Objective: The aim of this study was to analyze the advantages and disadvantages of clean intermittent catheterization, comparing to indwelling urinary catheter, in the treatment of chronic urinary retention. Methods: This literature review was carried out in order to highlight the best evidences for the choice between treatments. The extensive literature review was made through PubMed and Cochrane National Library. We selected the main articles published between 1950 and 2007, using urinary retention, indwelling urinary catheter, and clean intermittent catheterization as keywords. Results: Twenty five papers were selected, including three meta-analyses evaluating the long-term complications of clean intermittent catheterization, prophylactic intervention, and catheter types. Most articles discussed complications in patients with neurologic dysfunctions. Conclusion: Clean intermittent catheterization is better than indwelling catheter, as it is related to lower complication rates, both short and long-term. Indwelling catheterization was associated with decreased vesical compliance and bladder calculi, among others.

Objetivo: O objetivo do estudo foi analisar quais as vantagens e desvantagens do uso do cateterismo intermitente limpo, se comparado à sonda vesical de demora, no tratamento dos pacientes com retenção urinária crônica. Métodos: O estudo foi feito por meio da revisão da literatura, com o objetivo de destacar as melhores evidências para a realização de um ou de outro tratamento. A pesquisa bibliográfica foi realizada no PubMed e na Cochrane Library. As palavras-chave utilizadas foram retenção urinária, cateteres de demora e cateterismo intermitente limpo, e os artigos foram selecionados no período compreendido entre 1950 e 2007. Resultados: Dos 25 artigos selecionados, foram incluídas três metanálises, que avaliaram as complicações em longo prazo do uso do cateterismo intermitente limpo, medidas profiláticas para manuseio do cateter e tipos de cateter utilizados. A grande maioria dos artigos selecionados se referiu ao tratamento e manuseio das complicações em pacientes com disfunções neurológicas. Conclusões: O cateterismo intermitente demonstrou ser superior à sondagem de demora, pois está associado a uma menor taxa de complicações a curto e a longo prazo, como, por exemplo, cálculos vesicais, redução da complacência vesical, dentre outras.