Bladder outlet obstruction after pubovaginal fascial sling.

The purpose of this cross-sectional study was to evaluate patients' satisfaction and urodynamic findings in women undergoing pubovaginal fascial sling procedure. We have evaluated, clinically and urodynamically, 45 women who underwent the rectus fascia pubovaginal sling for urodynamically proven stress urinary incontinence with at least 12 months of postoperative follow-up. After a mean follow-up of 25 months, 93.3% of patients reported being stress continent and 73.3% were satisfied with the result of the surgery. Patients with longer follow-up had a significantly lower satisfaction score (6.4 vs. 9.3, p = 0.005). Using the Blaivas-Groutz nomogram, some degree of obstruction was observed in 51.1% of women. Storage symptoms were related to obstruction (p = 0.004), longer follow-up (p = 0.022), and negative impact on quality of life. Half of the patients had some degree of obstruction, which was directly related to urge syndrome and decrease in quality of life.

Xanthogranulomatous pyelonephritis: clinical experience with 41 cases.

OBJECTIVES: Xanthogranulomatous pyelonephritis (XGP) is an uncommon inflammation of the renal parenchyma that occurs in the presence of chronic obstruction and suppuration. In this retrospective study, a review of the features of 41 recent cases of XGP is presented and compared with current published data. METHODS: We retrospectively evaluated the clinical, surgical, and radiologic features of 41 cases of XGP and compared the data of this Brazilian population with that from current published reports. RESULTS: XGP was diagnosed in 19.2% of all nephrectomies performed for pyelonephritis during the period analyzed. Of the 41 patients with XGP, 85.4% were women and 14.6% were men. All patients were symptomatic, and the most common symptoms were fever, flank or abdominal pain, weight loss, lower urinary tract symptoms, and gross hematuria. The most frequent computed tomography findings included hydronephrosis, kidney enlargement, poor excretion of contrast medium, and air in the urinary tract. All patients had renal calculi, 34.1% of which were staghorn calculi. All patients underwent nephrectomy. For the few cases in which laparoscopy was performed, the conversion rate was high. CONCLUSIONS: XGP is a common histologic variant of surgically managed pyelonephritis, corresponding to almost 20% of such cases. As described in other series, we found a population that largely consisted of middle-age women. The clinical presentation was characterized mainly by pain and constitutional symptoms. The main etiologic agent isolated was Escherichia coli, and in all cases, calculi were present. Computed tomography can be considered the best imaging study to diagnose XGP, and in the few cases managed by laparoscopy, high conversion rates were observed.

Recreational use of PDE5 inhibitors by young healthy men: recognizing this issue among medical students.

INTRODUCTION: In recent years, recreational use of phosphodiesterase type 5 (PDE5) inhibitors has become popular as a sexual enhancement aid among some men without erectile dysfunction (ED) and even among women. AIM: The aim of the present study, therefore, was to investigate the recreational use of PDE5 among young and healthy men. MAIN OUTCOME MEASURES: We evaluated the use of PDE5 inhibitors among young and healthy men, their main reasons for using these drugs, and their expectations regarding its effects. METHODS: A survey was carried out among 167 male medical students (21.2 +/- 2.3 years, range 17-31). The surveys were divided into domains, assessing epidemiological data, use of PDE5 inhibitor, and the simplified International Index of Erectile Function (IIEF-5). RESULTS: All men considered themselves with perfect erectile function. However, 9% reported previous use of PDE5 inhibitors. Of these, 46.7% had used PDE5 inhibitors more than three times, and 71.4% had mixed them with alcohol. Among this group of men, 13.3% had ED according to the IIEF-5. ED occurring with condom use, however, was twice more common, and 71.4% of the men who had taken PDE5 inhibitors thought that the drug had potential to facilitate condom use. CONCLUSION: In conclusion, the use of PDE5 inhibitors by young men is more frequent than previously reported. Condom-related ED seems to be an underestimated problem, frequently solved with PDE5 inhibitors. However, potential deleterious effects might exist. Because PDE5 inhibitors are being used as non-prescribed drugs by as much as 9% of young men, further studies must evaluate the effects of these drugs in young and healthy men.

Coexistence of prostate neoplasia in patients undergoing radical cystoprostatectomy due to vesical neoplasia

OBJECTIVE: To assess the incidence of bladder carcinoma infiltrating the prostate and prostate adenocarcinoma in patients undergoing radical cystoprostatectomy due to bladder cancer, as well as to assess if the characteristics of the bladder neoplasia influence the prostatic involvement by this neoplasia. MATERIALS AND METHODS: We retrospectively assessed 60 male patients, who underwent radical cystoprostatectomy between July 1997 and December 2003. Mean age was 66.7 years (40 and 93 years). The product of radical cystoprostatectomies was checked for involvement of urethra and prostate parenchyma by the primary neoplasia, and for the presence of associated prostate adenocarcinoma. Bladder neoplasia characteristics, such as localization, size, multifocality, association with in situ carcinoma and histological grade, were studied in order to assess the possibility of using such characteristics as predictive factors of prostate infiltration by bladder urothelial carcinoma. RESULTS: We observed the presence of 20 percent of patients with bladder carcinoma infiltrating the prostatic urethra, 23.3 percent of patients with infiltration of the prostate parenchyma and 28.3 percent of patients with associate prostate adenocarcinoma, resulting in a total of 55 percent of patients with prostatic involvement (infiltrative bladder carcinoma and/or adenocarcinoma). We also observed a statistically significant correlation between tumor location in the trigone, the presence of in situ carcinoma and the histological grade of the bladder tumor with prostatic infiltration by the vesical neoplasia. CONCLUSION: The coexistence of prostatic neoplasia in patients operated for bladder neoplasia was frequent in our sample (55 percent). We observed that the prostatic infiltration by bladder tumors occurs more frequently with tumors located in the trigone, with associated in situ carcinoma and with high histological grade. There was no correlation between neoplastic infiltration of prostate and multifocality or size of the bladder tumor in the studied sample.

Coexistence of prostate neoplasia in patients undergoing radical cystoprostatectomy due to vesical neoplasia.

OBJECTIVE: To assess the incidence of bladder carcinoma infiltrating the prostate and prostate adenocarcinoma in patients undergoing radical cystoprostatectomy due to bladder cancer, as well as to assess if the characteristics of the bladder neoplasia influence the prostatic involvement by this neoplasia. MATERIALS AND METHODS: We retrospectively assessed 60 male patients, who underwent radical cystoprostatectomy between July 1997 and December 2003. Mean age was 66.7 years (40 and 93 years). The product of radical cystoprostatectomies was checked for involvement of urethra and prostate parenchyma by the primary neoplasia, and for the presence of associated prostate adenocarcinoma. Bladder neoplasia characteristics, such as localization, size, multifocality, association with in situ carcinoma and histological grade, were studied in order to assess the possibility of using such characteristics as predictive factors of prostate infiltration by bladder urothelial carcinoma. RESULTS: We observed the presence of 20% of patients with bladder carcinoma infiltrating the prostatic urethra, 23.3% of patients with infiltration of the prostate parenchyma and 28.3% of patients with associate prostate adenocarcinoma, resulting in a total of 55% of patients with prostatic involvement (infiltrative bladder carcinoma and/or adenocarcinoma). We also observed a statistically significant correlation between tumor location in the trigone, the presence of in situ carcinoma and the histological grade of the bladder tumor with prostatic infiltration by the vesical neoplasia. CONCLUSION: The coexistence of prostatic neoplasia in patients operated for bladder neoplasia was frequent in our sample (55%). We observed that the prostatic infiltration by bladder tumors occurs more frequently with tumors located in the trigone, with associated in situ carcinoma and with high histological grade. There was no correlation between neoplastic infiltration of prostate and multifocality or size of the bladder tumor in the studied sample.