Quality of life evaluation of patients with neurogenic bladder submitted to reconstructive urological surgeries preserving the bladder.

Treatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36(®) and Qualiveen(®) QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36(®) questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p <0.05). The questionnaire also revealed Qualiveen(®) best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p <0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.

Quality of life evaluation of patients with neurogenic bladder submitted to reconstructive urological surgeries preserving the bladder

Treatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36® and Qualiveen® QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36® questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p <0.05). The questionnaire also revealed Qualiveen® best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p <0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.

The Amatsu's tracheoesophageal shunt: analysis of 84 cases.

INTRODUCTION: Amatsu's tracheoesophageal shunt can be indicated for vocal rehabilitation in candidates to total laryngectomy. It is performed in the period of the procedure of total laryngectomy and has been indicated due to its technical facility, exemption from the use of voice prosthesis, and lack of additional costs for its maintenance. OBJECTIVE: To evaluate the results obtained with the Amatsu's tracheoesophageal shunt, along 14 years of experience, in two Brazilian hospitals. STUDY DESIGN: Clinical retrospective. MATERIAL AND METHOD: From 1991 to 2005, eighty-four patients were submitted to the Amatsu's tracheoesophageal shunt. Seventy-seven (91.7%) were male and seven (8.3%) female, aged between 30 and 82 years, mean age of 57.5 years, and an average age of 52 years. All patients had squamous cell carcinoma of larynx and/or hypopharynx. Sixty-eight (81.0%) were stage III or IV. They were submitted to total laryngectomy and the Amatsu's tracheoesophageal shunt was performed during the tumor removal surgery. The following variables were analyzed: acquisition of intelligible speech, vocal recovery time after surgery, and the occurrence of specific surgical complications of the shunt (pulmonary aspiration). RESULTS: Seventy-six patients were evaluated with respect to the effectiveness of the technique. Fifty-three patients (70.0%) presented vocalization by the shunt; in 46 patients (60.5%), the speech was fully intelligible. The time required for restoration of speech was 12-87 postoperative days. Of the 83 patients evaluated in relation to the development of complications, 25 (30.1%) presented aspiration by the shunt during oral ingestion. In 23 patients (27.7%), the aspiration was managed conservatively without complications. Two patients (2.4%) required surgical closure of the shunt due to intractable aspiration. CONCLUSION: Vocal rehabilitation with the Amatsu's tracheoesophageal shunt is effective in most patients who underwent total laryngectomy. It can be evidenced by the acquisition of intelligible speech in most patients. The aspiration, although often, is not shown to be a limiting complication.

Há indicação para a realização da cirurgia de separação laringotraqueal para a prevenção de aspiração pulmonar em pacientes com tumores de cabeça e pescoço? / Is there indication to make laryngotracheal separation surgery for the prevention of pulmonary aspiration in patients with head and neck tumors?

Objetivo: Avaliar os resultados obtidos em pacientes com câncerde cabeça e pescoço submetidos à extensas ressecções dasvias aéreas e digestivas superiores associada à cirurgia deseparação laringotraqueal (SLT). Esta tinha o objetivo de prevenirpotencial aspiração pós-operatória. Desenho do Estudo:Análise retrospectiva. Estabelecimentos: Hospital das Clínicasda Universidade Federal de Minas Gerais (UFMG) e o HospitalBiocor. Método: Análise dos prontuários médicos de 30 pacientescom câncer de cabeça e pescoço, cuja exérese tem, sabidamente,grande potencial de causar aspiração pulmonar no pós-operatória.Eles foram submetidos à que se submeteram à realização da SLTjuntamente com a ressecção do tumor, no período de 1991 a 2008.As seguintes variáveis foram avaliadas: prevenção de potenciale grave aspiração pulmonar pós-operatória, morbidade e taxade reversibilidade da LTS. Resultados: A cirurgia foi eficaz em100,0% dos casos. Seis (20,0%) pacientes tiveram complicaçõespós-operatórias, ou seja, edema, estenose de traqueostomia efístula traqueocutânea do coto proximal da traqueia. A cirurgiapara reversão LTS foi realizada em 11 (36,7%) pacientes, sendoeficaz em nove (81,8%); cinco (45,5%) tiveram complicaçõespós-operatórias. Conclusões: A SLT impediu a ocorrência deaspiração pulmonar pós-operatória em pacientes submetidos àextensas ressecções das vias aéreas e digestivas superiores. Oprocedimento é potencialmente reversível e tem uma alta taxa deeficácia. No entanto, a frequência de complicações para ambasLTS e, especialmente sua reversão, não pode ser negligenciada.Descritores: separação laringotraqueal, prevenção de aspiraçãopulmonar, câncer de cabeça e pescoço, deglutição, desordens dedeglutição.