Safe urodynamic practices in times of COVID-19: What can be accomplished and what can be added?

AIM: To present feedback, after applying national and international urodynamic study (UDS) recommendations for safe practice during the COVID-19 pandemic. METHODS: We created a checklist to assess the feasibility of performing UDS recommendations for safe practice during the COVID-19 pandemic from the first week of May 2021 to the last week of July 2021. RESULTS: One hundred patients were analyzed during the study period. We observed that all preventive recommendations for the steps that precede UDS could be followed in full. However, some guidelines for performing the exam were not feasible in all patients. We have successfully adopted other safety measures for all patients. CONCLUSIONS: The COVID-19 pandemic will likely persist for several more years. We believe that continuous improvement, revision, and updating of existing protocols and guidelines for the safe practice of UDS in times of COVID-19, as we propose in this study, should be encouraged.

Comparison of vesical pressure values achieved by Valsalva maneuvers: A standardization proposal.

AIMS: To perform a comparative evaluation of Valsalva maneuver techniques, in an attempt to identify the most suitable one for achieving leak point pressure (LPP) during the cystometric phase of the urodynamic study (UDS), in order to propose a method for technical standardization. METHODS: Urodynamic data from women with stress urinary incontinence at three urogynecological medical centers were randomly selected and prospectively analyzed. Valsalva maneuver was executed through forceful attempted exhalation against the dorsal surface of the hand (Group 1), through abdominal strain (Group 2), or through low-elasticity latex balloon-blowing (Group 3). Patients were classified based on age and higher vesical pressure value, as well as time to perform Valsalva maneuver. RESULTS: Initially, 1358 urodynamic studies were identified as eligible for analysis. Among these, 340 belonged to Group 1, 318 to Group 2, and 700 to Group 3. Valsalva maneuver accomplished through abdominal straining was more effective, inducing increased vesical pressure, across age groups. The same maneuver may be sustained for longer than the other two techniques. CONCLUSION: When performed through abdominal strain, the Valsalva maneuver was more effective for stress urinary incontinence urodynamic's investigation.

Anatomo-radiological mapping of the arrangement of ascending lumbar veins in relation to renal veins: is there a way to predict the risk of intraoperative lesions?

The aim of our study was to describe the critical area for iatrogenic lesions of the lumbar veins during the intraoperative manipulation of the renal veins and propose predictive indications for identifying those veins found in potential risk for iatrogenic lesions. Adult human cadavers were dissected and contrast enhanced images of CT and MR scans were randomly selected and analyzed. The distances from the first lumbar veins to the right and left renal veins were measured, respectively. The diameter of the renal veins and of the inferior vena cava was calculated. Correlation of the distances between the first lumbar veins and the corresponding renal veins, as well as the diameter of the renal veins and the inferior vena cava was performed. We obtained 205 specimens. The average distances between the right and left first lumbar veins and their respective renal veins was 3,5cm and 3,8cm, respectively (p<0.0001). We found 40 (20%), 96 (46%) and 69 (34%) lumbar veins at high, moderate and low risk for intraoperative lesion, on the right side, respectively, and 34 (17%), 86 (42%) and 85 (41%) lumbar veins, on the left side, respectively. The correlation between the size of the renal veins and the first lumbar vein-renal vein distance found a statistically significant difference, only on the left side (p=0.02). We describe the arrangement of the lumbar veins in relation to the renal veins, proposing a way to predict the existence of a ‘risk zone’ for inadvertent, intraoperative vascular lesions

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Analysis of renal hilumextraparenchymal structures in Brazilian adult human cadavers

Anatomical knowledge of the exact topography of the renal hilar structures is of great importance when performing urological surgical procedures. Classically, the topographic distribution of hilar structures has been described in the antero-posterior direction as the renal vein-artery-pelvis complex. However, morphological studies have reported different dispositions. One hundred and thirteen renal hila from adult Brazilian human cadavers were dissected. The topographic analysis of hilar structures disposition was made at a distance of approximately 0.5 cm from the anterior border of the renal hilum, conserving the antero-posterior distribution. Only the renal artery, renal vein and renal pelvis were considered. The following antero-posterior distributions were observed: 94 (83%) presented the classic topographic organization: renal vein - renal artery - renal pelvis; 3 left kidneys (3%) presented the renal «vein-pelvis-artery» disposition; 3 kidneys (3%) presented the renal «artery-vein-pelvis» disposition; 1 left kidney (1%) presented the renal «artery-pelvis-vein» disposition; 12 kidneys (10%) presented an undefined organization of hilar structures. An atypical distribution of segmentary arteries related to renal hilar structures was found. We believe this study may contribute to a better knowledge of the topographical organization of the renal hilum, which is a region frequently involved in surgical dissection during urological surgical procedures of the kidney (AU)

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