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Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:35:37Z No. of bitstreams: 1 Rodrigo Barros de Castro Tese completa.pdf: 14989903 bytes, checksum: ca661387ad922a06d5dbd62eb53fdd30 (MD5) Made available in DSpace on 2021-01-05T19:35:37Z (GMT). No. of bitstreams: 1 Rodrigo Barros de Castro Tese completa.pdf: 14989903 bytes, checksum: ca661387ad922a06d5dbd62eb53fdd30 (MD5) Previous issue date: 2019-04-29 Evidence has shown a trend towards following urgent surgical exploration of penile fracture (PF) which aims to restore the anatomical and functional integrity of the penis, in order to avoid complications and sexual dysfunctions. The aim of this study was to conduct a comprehensive assessment of sexual function of patients undergoing surgical treatment of PF, covering psychological aspects related to trauma. Patients undergoing surgical treatment of PF from January 2014 to August 2017 were followed-up in our department for at least 6 months. Those patients answered the International Index of Erectile Function (IIEF-5), The Premature Ejaculation Diagnostic Tool (PEDT) and a psychosexual interview. Penile color duplex Doppler ultrasound (CDDU) was performed for those who had persistent erectile dysfunction (ED) to obtain a precise etiological diagnosis. Finally, we searched the penis and interviewed the patients about any evidence of pain in erection, penile nodules or curvature acquired after surgery. A total of 58 patients conducted the follow-up. The mean age was 38.5 years (range: 18-66 years). The sexual etiology was observed in 46 (79.3%) cases and non-sexual in 12 (20.6%). Only one patient had ED before the trauma. The duration of follow-up ranged from 6 to 48 months (mean: 11.4). Five (8.6%) patients had low libido, one (1.7%) patient reported delayed ejaculation and five (8.6%) developed acquired premature ejaculation. Eight (13.7%) patients complained of penile curvature after surgery. Intracavernosal injection test showed deviation < 30 ° in all cases. Penile fibrotic nodule was found in 44 (75.8%) patients and painful erections in 16 (27.5%) cases. Five (8.6%) patients complained of a decrease in the size of the penis in the postoperative period. Postoperative erectile function was recovered after six months in 50 (86.2%) cases. After the last evaluation at 18 months, only one patient developed persistent ED and CDDU excluded a vascular etiology. The only case of prior ED had no change in erectile function. Psychosexual evaluations showed that 45 (77.5%) patients feared a new episode of PF. Changes in sexual habits, such as avoiding vigorous sexual intercourse, were reported by 40 (68.9%) patients. Among 18 (31%) patients who reported a negative impact on sexual life, performance anxiety was performed by 17 (29.3%) of them. Of the 46 sexual etiology cases, 17 (36.9%) patients reported avoiding the position or cause that led to the trauma. Finally, patients with performance anxiety and those who reported a negative impact on sexual life were more susceptible to the development of ED (p = 0.0337 and p = 0.0418, respectively). Surgical treatment of PF provides satisfactory results with adequate recovery of sexual function, even in the long-term follow-up. Most patients preserve erectile function without the development of penile curvature or deformity. However, sexual complications such as ED, decreased libido, ejaculatory dysfunctions, curvature and penile nodule may occur in the late postoperative period and should be treated. Psychological sequela are very common, causing fear of recurrence and psychogenic ED, resulting in negative impact on the sexual life of these patients, who should be monitored closely. As evidências vêm mostrando que existe uma tendência na realização da exploração cirúrgica imediata na fratura peniana (FP), visando restaurar a integridade anatômica e funcional do pênis, a fim de evitar complicações e disfunções sexuais. O objetivo deste estudo foi realizar uma avaliação abrangente da função sexual de pacientes submetidos ao tratamento cirúrgico da FP, incluindo aspectos psicológicos relacionados ao trauma. Pacientes operados por FP de janeiro de 2014 a agosto de 2017 foram acompanhados em nosso serviço por pelo menos seis meses. Esses pacientes responderam aos questionários International Index of Erectile Function (IIEF-5) e The Premature Ejaculation Diagnostic Tool (PEDT) , além de uma entrevista psicossexual. Ultrassom do pênis com Doppler colorido (USGDC) foi realizado naqueles que tinham disfunção erétil (DE) persistente para obter um diagnóstico etiológico preciso. Finalmente, os pacientes foram examinados e arguidos sobre qualquer evidência de dor na ereção, nódulos penianos ou curvatura adquirida após a cirurgia. Um total de 58 pacientes realizou o seguimento. A média de idade foi de 38,5 anos (variação de 18 a 66 anos). A etiologia sexual foi observada em 46 (79,3%) casos e não sexual em 12 (20,6%). Apenas um paciente apresentava DE antes do trauma. O seguimento variou de seis a 48 meses (média: 11,4). Cinco (8,6%) pacientes apresentaram diminuição da libido, um (1,7%) relatou ejaculação retardada e cinco (8,6%) desenvolveram ejaculação precoce. Oito (13,7%) pacientes queixaram-se de curvatura peniana após a cirurgia. O teste de injeção intracavernosa demonstrou desvio < 30 ° em todos os casos. Nódulo fibrótico peniano foi encontrado em 44 (75,8%) pacientes e ereções dolorosas em 16 (27,5%) casos. Cinco (8,6%) pacientes queixaram-se de uma diminuição no tamanho do pênis no período pós-operatório. A função erétil pós-operatória foi recuperada após seis meses em 50 (86,2%) pacientes. Após a última avaliação aos 18 meses, apenas um paciente desenvolveu DE persistente e o USGDC excluiu etiologia vascular. O único caso de DE prévia não apresentou alteração da função erétil. Avaliações psicossexuais mostraram que 45 (77,5%) pacientes temiam um novo episódio de FP. Mudanças nos hábitos sexuais, como evitar relações sexuais vigorosas, foram reportadas por 40 (68,9%) pacientes. Entre 18 (31%) pacientes que relataram impacto negativo na vida sexual, a ansiedade de desempenho foi revelada por 17 (29,3%) deles. Dos 46 casos de etiologia sexual, 17 (36,9%) pacientes relataram evitar a posição que levou ao trauma. Finalmente, os pacientes com ansiedade de desempenho e aqueles que relataram um impacto negativo na vida sexual foram mais suscetíveis ao desenvolvimento de DE (p = 0,0337 e p = 0,0418, respectivamente). Podemos concluir que o tratamento cirúrgico da FP proporciona resultados satisfatórios, com recuperação adequada da função sexual, mesmo no seguimento a longo prazo. A maioria dos pacientes preserva a função erétil sem o desenvolvimento de curvatura ou deformidade peniana. Entretanto, complicações sexuais como DE, diminuição da libido, disfunções ejaculatórias, curvatura e nódulo peniano podem ocorrer no pós-operatório tardio e devem ser tratadas. Sequelas psicológicas são muito comuns, causando medo de recorrência e DE psicogênica, resultando em impacto negativo na vida sexual desses pacientes, que devem ser acompanhados de perto.

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:35:35Z No. of bitstreams: 1 Paulo Ornellas de Souza Tese completa.pdf: 7023595 bytes, checksum: 9e216395a639778b0a91152cc7aed3c2 (MD5) Made available in DSpace on 2021-01-05T19:35:35Z (GMT). No. of bitstreams: 1 Paulo Ornellas de Souza Tese completa.pdf: 7023595 bytes, checksum: 9e216395a639778b0a91152cc7aed3c2 (MD5) Previous issue date: 2018-12-17 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Squamous cell carcinoma of penis (SCCP) accounts for 95% of all types of penile cancer. In Brazil, the incidence is 2.7%, but in some areas of the country, the incidence can reach 17% of the diagnosed cases of cancer per year. It is an aggressive disease whose survival over 5 years is around 85% for stages I and II, but can reach 11% in advanced cases. Clinical practice is not a reliable indicator of lymph node involvement and survival. Therefore, it is important to have new classification strategies. Tumor markers may be a new strategy. In our previous study it was described that the C3 and C4a/b fragments of the complement system were underexpressed in patient with SCCP when compared with health individuals. The objective was to validate the subexpression of the complement system C3a protein as a biomarker. We investigated the possibility of C3a protein being a biomarker in the diagnosis of these patients using a commercial enzyme immunoassay kit (ELISA - BD BioscienceOptEIA Human C3a Kit). The C3a protein was evaluated in plasma samples from 39 patients with SCCP, 50 healthy controls and 15 patients with prostate cancer. The non-parametric Mann-Whitney test was used to compare the medians between groups. Corroborating with our previous results, C3a protein was shown to be significantly underexpressed in patients with SCCP compared to control and prostate cancer patients (p

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:39:43Z No. of bitstreams: 1 Lilian de Castro Ponzoni Dissertacao completa.pdf: 799217 bytes, checksum: e25250439cd8ce2fec7e7efbed6644f9 (MD5) Made available in DSpace on 2021-01-05T19:39:43Z (GMT). No. of bitstreams: 1 Lilian de Castro Ponzoni Dissertacao completa.pdf: 799217 bytes, checksum: e25250439cd8ce2fec7e7efbed6644f9 (MD5) Previous issue date: 2018-09-17 Effective control of urethral closure mechanisms is essential for female urinary continence, involving mechanism similar to that required for sacroiliac stability. Studies have demonstrated benefits in the functional rehabilitation of the pelvic floor, after treatment of patients with low back pain, using osteopathic manipulation techniques. The primary objective of this study was to evaluate the improvement of urinary incontinence after musculoskeletal manipulation (OMT), associated with pelvic physiotherapy (PF). Patients from the Physiotherapy Division of the Policlínica Piquet Carneiro / UERJ, diagnosed with uncomplicated urinary incontinence, aged between 21 and 65 years, answered the questionnaires: International Consultation on Incontinence Questionnaire - Short Form - ICIQ, Stress Urinary Incontinence Questionnaire - SUIQ, Overactive Bladder Questionnaire - ICIQ-OAB qol, and the Euroqol-5D - EQ5D. The perineal force was evaluated through functional evaluation of the pelvic floor (AFA). Patients were divided: in the FP group submitted to the FP protocol, and in the OMT group submitted to the same protocol, associated with OMT, for 10 weeks. In the present study the use of OMT associated with PF, obtained results similar to the use of PF alone, and did not add improvement in the response to treatment of uncomplicated urinary incontinence. Controle eficiente dos mecanismos de fechamento uretral é essencial para continência urinária feminina, envolvendo mecanismo similar ao necessário para estabilidade sacroilíaca. Estudos demonstraram benefícios na reabilitação funcional do assoalho pélvico, após tratamento de pacientes com lombalgia, utilizando técnicas de manipulação osteopática. O objetivo primário deste estudo foi avaliar melhora da incontinência urinária após tratamento manipulativo osteopático musculoesquelético (TMO), associado com fisioterapia pélvica (FP). Participaram pacientes da divisão de fisioterapia da Policlínica Piquet Carneiro/UERJ, com diagnóstico de incontinência urinária não complicada, com idade entre 21 e 65 anos, e que responderam os questionários: International Consultation on Incontinence Questionnaire - Short Form - ICIQ, Stress Urinary Incontinance Questionnaire - SUIQ, Overactive Bladder Questionnaire - ICIQ-OAB qol, e o euroqol-5D EQ5D. A força perineal foi avaliada através do teste de avaliação funcional do assoalho pélvico (AFA), e as pacientes foram divididas em dois grupos: no grupo FP foram submetidas ao protocolo de FP por 10 semanas, e no grupo TMO foram submetidas ao mesmo protocolo, associado com TMO, pelo mesmo período. No presente estudo a utilização do TMO associado a FP, obteve resultados semelhantes a utilização de FP isoladamente, não acrescentando melhora na resposta ao tratamento da incontinência urinária não complicada.

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:40:17Z No. of bitstreams: 1 Rogerio Alves Barboza Dissertacao completa.pdf: 1005757 bytes, checksum: cd8016df86531c1f28950b9369cff9ba (MD5) Made available in DSpace on 2021-01-05T19:40:17Z (GMT). No. of bitstreams: 1 Rogerio Alves Barboza Dissertacao completa.pdf: 1005757 bytes, checksum: cd8016df86531c1f28950b9369cff9ba (MD5) Previous issue date: 2017-11-27 This is an observational transversal cohort study in which we aim to analyze the Brazilian penis length and compare the penis size of the men self-declared as white (SDW) or black (SDB) skin color. The Subjects were asked for self-declare according to their skin color, after that they have been invited to participate in a semi-structured interview so as to have their perception evaluated regarding their penis size and their self-esteem as well. Eventually, their penis length was measured with an anthropometric ruler. The men´s mean penis length who declared themselves as black skin color was 16.5±1.7cm (penis length in real fully-stretched flaccid length) and the men´s mean penis length who declared themselves as white skin color was 15.8±1.6cm (p

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:41:54Z No. of bitstreams: 1 Ericka Kirsthine Valentin Dissertacao completa.pdf: 1427331 bytes, checksum: c2b7142e3803d8e18fefc51a23f53ee1 (MD5) Made available in DSpace on 2021-01-05T19:41:54Z (GMT). No. of bitstreams: 1 Ericka Kirsthine Valentin Dissertacao completa.pdf: 1427331 bytes, checksum: c2b7142e3803d8e18fefc51a23f53ee1 (MD5) Previous issue date: 2014-03-31 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior This cross-sectional study of female patients who attended the Department of Urology and Urodynamic of the Endoscopy Department of Urology, Pedro Ernesto University Hospital HUPE/UERJ between December 2009 and December 2012, for performing urodynamic study with medical referral and scheduling prior to investigation of stress urinary incontinence. The study was conducted in female patients, aged between 23 and 86 years with complaints of urinary uncomplicated incontinence. The data used in this study have three origins: (1) the primary assessment formed by the set of questionnaire and loss effort or urgency and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and standardized history; (2) medical evaluation performed by a resident physician; and (3) urodynamic evaluation, results of urodynamic study conducted by resident physician, with supervision and reports made by one of the Professors of the service. The objective was to analyze whether the use of simpler methods could diagnose uncomplicated urinary incontinence without the need for urodynamic evaluation. Our findings showed that between primary medical evaluation and there is high sensitivity and specificity in addition to strong agreement. The urodynamic study is less likely to make the diagnosis of MUI and higher frequency of false negative. Our findings strengthen the indication of a primary approach before more invasive and costly interventions such as urodynamic evaluation. The realization of a simplified assessment can provide enough to get a drug and physical therapy information. Este é um estudo transversal feito com pacientes mulheres que compareceram ao Setor de Endoscopia Urológica e Urodinâmica do Serviço de Urologia do Hospital Universitário Pedro Ernesto HUPE entre dezembro de 2009 e dezembro de 2012, para a realização de estudo urodinâmico, com encaminhamento médico e agendamento prévio para investigação de queixa de incontinência urinária. O estudo foi realizado nas pacientes do sexo feminino, com idade entre 23 e 86 anos e com queixa de incontinência urinária nao complicada. Os dados utilizados nesse estudo têm três origens: (1) a avaliação primária formada pelo conjunto dos questionário de perda por esforço e ou urgência e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) e história padronizada; (2) avaliação médica, realizada pelo médico residente; e (3) avaliação urodinâmica, resultado do estudo urodinâmico conduzido por médico residente, com supervisão e laudos feitos por um dos professores do serviço. O objetivo do trabalho foi analisar se o uso de métodos mais simples poderia diagnosticar incontinência urinária não complicada sem a necessidade de realizar a avaliação urodinâmica. Os nossos achados mostraram que entre a avaliação primária e a médica há elevada sensibilidade e especificidade além de forte concordância. O estudo urodinâmico tem menor probabilidade de fazer o diagnostico de IUM e maior frequencia de falso negativo. Os nossos achados fortalecem a indicação de uma abordagem primária antes de intervenções mais invasivas e dispendiosas como a avaliação urodinâmica. A realização de uma avaliação simplificada pode fornecer informações suficientes para começar um tratamento medicamentoso e fisioterapêutico.

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:41:35Z No. of bitstreams: 1 DISSERTACAO_FINAL_Paulo Ornellas de Souza.pdf: 5700098 bytes, checksum: 6b717b2aa67ee5400fb93b10c679c825 (MD5) Made available in DSpace on 2021-01-05T19:41:35Z (GMT). No. of bitstreams: 1 DISSERTACAO_FINAL_Paulo Ornellas de Souza.pdf: 5700098 bytes, checksum: 6b717b2aa67ee5400fb93b10c679c825 (MD5) Previous issue date: 2013-08-28 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Squamous cell carcinoma of the penis (SSCP) represents 95% of penile cancers. It affects mostly uncircumcised patients and is often associated with lack of adequate local hygiene and phimosis. In Brazil, the incidence is 2.7% but in some areas of the country can reach 17% of diagnosed cases of cancer per year. The tumor can occur in any part of the sexual organ and the type of staging to be used is controversial. The Broders classification is more often used to classify tumors. Studies suggest the relationship between the development of penile carcinoma and HPV infection (Human Papilloma Virus). The evaluation method of inguinal lymph nodes remains controversial and it is difficult to differentiate inflammatory reaction from metastatic lymphadenopathy. Physical examination is not a reliable predictor of lymph node involvement since patients with palpable lymph nodes can not present metastases. There are few publications about the molecular mechanisms involved in the genesis and progression of the SSCP. Although several markers have been evaluated, currently the clinical application of these is limited. Most of the markers studied require invasive procedures for obtaining tumor tissue. There is a need to find through a minimally invasive technique circulating tumor markers able to differentiate SSCP patients with and without metastatic involvement. In this type ofmalignancythediscovery of biomarkers that assessthe prognosisis relevant since physical examination is not a reliable predictor oflymph node involvementand survival. The objectives of this study were: 1) to review and discuss the epidemiology, etiology, different types of surgical approach and controversies in the surgical treatment of penile cancer 2)to investigate via the platform ClinProt / MALDI / TOF presence of plasma markers able to discriminate healthy subjects from patients affected by squamous cell carcinoma of the penis (SCCP) 3) to evaluate the importance of these markers in disease progression. Between June 2010 and June 2011, plasma samples from 36 healthy subjects and 25 patients with penile carcinoma who underwent surgical treatment in the UrologyServicesofNational Cancer InstituteandMarioKröeffHospital were collected and analyzed by the ClinProt/MALDI/TOF platform. Our results found a cluster of 2 peptides (A=m/z 1897.22 +-9 Da and B=m/z 2021.99 +-9 Da that was able to discriminate patients from controls subjects. These peptides were further identified as C3 and C4 A/B fragments from complement system. Cross validation analysis using the whole casuistic showed 62.5% and 86.76% of sensitivity and specificity, respectively with a very high sensitivity (100%) and specificity (97%) for SCCP patients that have died by disease. Moreover, patients with lymph node involvement present a sensitivity and specificity of 80% and 97%, respectively. The results showed that as the disease progresses more under express are the cluster comparing with healthy subjects. These results may be useful as prognostic toll. O carcinoma epidermóide de pênis (CEP) representa 95% das neoplasias penianas e afeta quase sempre pacientes não circuncidados estando muitas vezes associado à falta de higiene local adequada e à fimose. No Brasil a sua incidência é de 2,7 % porém em algumas áreas do país pode chegar a 17% dos casos diagnosticados por ano. O tumor pode ocorrer em qualquer parte do órgão sexual masculino e o tipo de estadiamento empregado é controverso. A classificação de Broders é a mais utilizada. Estudos sugerem a relação entre o desenvolvimento do carcinoma de pênis com a infecção por HPV (Papiloma Vírus Humano). O método de avaliação dos linfonodos inguinais permanece controverso sendo difícil a diferenciação entre linfadenomegalia inflamatória reacional e metastática. O exame físico não é um preditor confiável do comprometimento linfonodal pois pacientes com linfonodos palpáveis podem não apresentar metástases. Há poucas publicações sobre os mecanismos moleculares envolvidos na gênese e progressão do CEP. Apesar de vários marcadores terem sido avaliados, atualmente a aplicação clínica destes é limitada. A maior parte dos marcadores estudados requer procedimentos invasivos para obtenção do tecido tumoral. Existe a necessidade de encontrar através de uma técnica pouco invasiva marcadores tumorais circulantes capazes de diferenciar portadores de CEP com e sem envolvimento metastático. Neste tipo de neoplasia, a descoberta de biomarcadores que avaliem o prognóstico é relevante, pois o exame físico não é um indicador confiável do comprometimento linfonodal e da sobrevida.Os objetivos foram 1) revisar e discutir a epidemiologia, a etiologia, os diversos tipos de abordagem cirúrgica e as controvérsias no tratamento cirúrgico do câncer de pênis 2) investigar através da plataforma ClinProt/ MALDI / TOF a presença de marcadores plasmáticos capazes de discriminar indivíduos saudáveis de pacientes afetados por carcinoma epidermóide de pênis (CEP) 3) avaliar a importância destes marcadores na evolução da doença. Foram coletados e analisados pela plataforma ClinProt / MALDI / TOF o plasma de 36 indivíduos saudáveis e 25 pacientes com CEP invasivo, submetidos a tratamento cirúrgico entre junho de 2010 e junho de 2011, nos serviços de urologia do Instituto Nacional de Câncer e do Hospital Mário Kröeff (Rio de Janeiro). Nossos resultados apontaram para um conjunto de dois peptídeos (A = m / z 1897,22 + -9 Da e B = m / z 2021,99 + -9 Da) que foram capazes de diferenciar pacientes com CEP de indivíduos controles. Esses peptídeos foram posteriormente identificados como fragmentos C3 e C4 A/B do sistema complemento. A validação cruzada, utilizando toda casuística apresentou 62,5% e 86,76% de sensibilidade e de especificidade, respectivamente, com uma alta sensibilidade (100%) e especificidade (97%) nos pacientes que morreram pela doença. Além disso, os pacientes com envolvimento ganglionar obtiveram uma sensibilidade e uma especificidade de 80 % e 97%, respectivamente. Ficou demonstrado que à medida que a doença progride mais subexpressos está o conjunto de peptídeos quando comparados com indivíduos saudáveis. Estes resultados podem ser úteis como ferramentas para a avaliação do prognóstico destes pacientes.

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:36:46Z No. of bitstreams: 1 Jose Ailton Fernandes Silva Tese completa.pdf: 1879115 bytes, checksum: e4551e416933d0188ac93e23dc3713ae (MD5) Made available in DSpace on 2021-01-05T19:36:46Z (GMT). No. of bitstreams: 1 Jose Ailton Fernandes Silva Tese completa.pdf: 1879115 bytes, checksum: e4551e416933d0188ac93e23dc3713ae (MD5) Previous issue date: 2013-04-08 To investigate the ultrasonographic bladder wall thickness (BWT), urodynamic parameters and evaluate the role of such measurements for the upper and lower urinary tract deterioration and also assess the role of changes in bladder shape in the outcome of botulinum toxin type A (BTX-A) into the detrusor in patients with spinal cord injury (SCI). There are two studies. First study was a cross-sectional study involving two hundred and seventy two patients with SCI who underwent renal and bladder ultrasonography and urodynamic evaluation. The anterior bladder wall was measured and compared to urodynamic data. Cystography was done in 57 patients. The second was a prospective study about injection of BTX-A into the detrusor performed in 27 patients considering urodynamic parameters and cystography findings. Mean BWT was 3.94 mm. BWT was statistically higher in patients with neurogenic detrusor overactivity associated to detrusor sphincter dyssynergia (NDO/DSD) and in those with compliance < 20 mL/cmH2O. Patients with low compliance (< 20 mL/cmH2O), had 4.2 times higher prevalence of hydronephrosis, compared to patients with compliance ≥ 20 mL/cmH2O. Mean of Pdet max was statistically higher in patients with vesicoureteral reflux (VUR) compared to those without (100.7 vs 61.2 cmH2O respectively, p=0.022). There was no statistical association between BWT and hydronephrosis or VUR. Twenty seven patients underwent injection of BTX-A into the detrusor. The average time of urinary continence was 8 months. Nine patients (33.3%) had altered bladder shape and 8 cases (29.6%) had diverticula. The maximum cystometric capacity, NDO, reflex volume and compliance showed no statistically significant difference in the presence of diverticula or altered bladder shape. Increased BWT is associated with low compliance and NDO/DSD in patients with SCI. However, there was no relationship between BWT and hydronephrosis or VUR. Low compliance and NDO/DSD are the main risk factors for the upper urinary tract damage. The presence of diverticula or changes in bladder shape did not influence the results after injection of BTX-A into the detrusor. Medir a espessura da parede vesical (EPV) através da ultrassonografia, correlacioná-la com os parâmetros urodinâmicos e avaliar o papel destes parâmetros para lesão do trato urinário superior. Avaliar também o papel das alterações da forma da bexiga nos resultados de injeção de toxina botulínica tipo-A (BTX-A) no detrusor em pacientes com lesão medular traumática (LMT). Trata-se de dois estudos. O primeiro é um estudo transversal de 272 pacientes com LMT submetidos à ultrassonografia renal e de bexiga e estudo urodinâmico. A parede anterior da bexiga foi medida e comparada com os dados urodinâmicos. A cistografia foi realizada em 57 pacientes. O segundo foi um estudo prospectivo avaliando os resultados da injeção de BTX-A no detrusor em 27 pacientes considerando os achados urodinâmicos (pré e pós procedimento) e as deformidades da bexiga (cistografia). A média da EPV foi de 3,94 mm e foi estatisticamente maior em pacientes com hiperatividade detrusora neurogênica associada à dissinergia vesicoesfincteriana (HDN/DVE), em comparação com aqueles sem DVE (p

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:36:20Z No. of bitstreams: 1 FINAL.pdf: 524076 bytes, checksum: 8ea54fe8bb2c6c2ae81e919096f6410b (MD5) Made available in DSpace on 2021-01-05T19:36:20Z (GMT). No. of bitstreams: 1 FINAL.pdf: 524076 bytes, checksum: 8ea54fe8bb2c6c2ae81e919096f6410b (MD5) Previous issue date: 2012-10-15 Radical prostatectomy (RP) is one of the most common treatment for localized prostate cancer (PCa), but despite the advances in the local anatomy knowledge and the technological development, this surgery remains related to high morbidity in the sexual sphere. The reduction in penile length after RP is a common complaint in urologic practice, but there is no data regarding this issue in a long follow-up period. The determination of the natural history of penile length after RP and possible risk factor is necessary for the counseling and treatment of patients undergoing this surgery. The objective of this study is to determine the natural history of penile length after RP in a five years follow-up and to investigate the role of erectile function in the penile length variation. We prospectively evaluated the penile length of 105 patients with localized prostate cancer submitted to open RP. Participation in penile rehabilitation programs and anatomical deformities of the penis were considered exclusion criteria. Measurements of the real length under maximum penile traction (RSLmax) were performed before and after RP at 3, 6, 12, 24, 36, 48 and 60 months postoperatively. The erectile function domain of the International Index of Erectile Function (IIEF-EF) was used to assess erectile function. There was a mean reduction of 1 cm in RSLmax in 3 months after the PR and this difference remained up to 24 months (p

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:35:32Z No. of bitstreams: 1 Tese - Joao Luiz Schiavini.pdf: 1162183 bytes, checksum: 3caf964114de1fe237dce3736e6eea3d (MD5) Made available in DSpace on 2021-01-05T19:35:32Z (GMT). No. of bitstreams: 1 Tese - Joao Luiz Schiavini.pdf: 1162183 bytes, checksum: 3caf964114de1fe237dce3736e6eea3d (MD5) Previous issue date: 2009-10-19 Meticulous incision or excision of the stenotic segment and any associated proximal and distal spongiofibrosis is critical to the reliable success of urethroplasty procedures. However, normal urethral limits are determined during surgical reconstruction based on macroscopic aspects only. To our knowledge, microscopic studies evaluating the normal urethral ends have not been done. We aimed to describe the histological pattern of the presumed healthy limits of the urethral stricture disease, and the effect of a suprapubic urinary diversion on the proximal urethral end. Materials and Methods: Samples were obtained from 29 patients 20 to 65 years old (mean age 40.3) who underwent end-to-end bulbar urethroplasty. After urethral strictured segments were excised, biopsies of the presumed healthy ends (proximal and distal) were performed. Structural characterization was evaluated by staining histological sections in Haematoxylin-Eosin, Masson s trichrome, Weigert s resorcin-fuchsin method, and picrosirius-polarization method. At least one month before urethroplasty, suprapubic urinary diversion was performed in fifteen (52%) patients. The control group consisted of 10 bulbar urethras obtained from fresh, macroscopically normal cadavers 21 to 32 years old (mean age 24.7). Results: Urethral strictures were due to contraction of the fibrous tissue which has begun to replace the normal structures of the corpus spongiosum. A replacement of the vascular sinusoids in the corpus spongiosum by a dense extracellular matrix (ECM) occurred in all patients. ECM was formed mainly by collagen (vast majority of them) and elastic fibers. No patient presented microscopic normal urethral ends. All urethral edges presented chronic and/or acute microscopic changes if compared to the control group. With regard to the proximal end, the deposit of ECM presented high cellular density in 18 (62.1%) cases. These cells were predominantly fibroblast and inflammatory cells and were related to the time of the urethral injury and the absence of a suprapubic urinary diversion. Also, in these patients, elastic fibres had a heterogeneous distribution in the proximal urethral end. Epithelial hyperplasia was found in 20 (69%) proximal urethral ends, and acute urethritis with mixed inflammatory cells was also evidenced. With regard to the distribution of collagen I and III, marked differences were found in all groups. Conclusion: Presumed healthy urethral ends of the end-to-end bulbar urethroplasty present structural changes. A suprapubic urinary diversion may influence the composition of the ECM in the proximal bulbar urethra. However, the clinical role of these findings needs further investigation. A realização meticulosa de uma incisão ou excisão do segmento estenosado e da esponjofibrose associada, proximal ou distal, é crítica para o sucesso da uretroplastia anterior. Entretanto, a normalidade das margens da uretra estenosada é determinada durante o procedimento cirúrgico, baseado apenas no aspecto macroscópico do tecido. Não se encontraram na literatura estudos microscópicos avaliando as margens normais. O objetivo deste trabalho é caracterizar o aspecto histológico das margens aparentemente normais da estenose uretral masculina e o efeito causado pela realização de uma cistostomia supra púbica na microestrutura da extremidade uretral proximal à estenose. Materiais e Método: As amostras foram obtidas de 29 pacientes com média de idade de 40,3 anos, variando de 20 a 65 anos, submetidos à uretroplastia bulbar término-terminal. O segmento estenosado foi removido e foram realizadas biópsias nas extremidades supostamente sadias (proximais e distais). A caracterização estrutural foi realizada pelas seguintes colorações histológicas: Hematoxilina/Eosina, tricrômico de Masson, resorcina-fucsina de Weigert e picrosirius polarizado. Em 15 pacientes (52%) foi realizada uma cistostomia suprapúbica, cerca de um mês antes da uretroplastia,. O grupo controle consistiu de 10 uretras bulbares macroscopicamente normais, obtidas de cadáveres frescos, com média de idade de 24,7 anos (entre 21 e 32 anos). Resultados: A estenose de uretra decorreu da retração cicatricial do tecido fibroso, constituído por uma matriz extracelular (MEC) densa em todos os casos, que ocupou os seios vasculares do corpo esponjoso. A MEC foi constituída, na sua maioria, principalmente por colágeno e fibras elásticas. Em nenhum paciente as margens uretrais eram normais. Todas as extremidades tinham alterações microscópicas agudas e/ou crônicas quando comparadas ao grupo controle. Nas extremidades proximais, o depósito de MEC tinha alta densidade celular em 18 casos (62,1%). Estas células foram predominantemente inflamatórias e fibroblastos. Sua presença se relacionou ao tempo de lesão uretral e à ausência de cistostomia suprapúbica. Além disso, as fibras elásticas tiveram distribuição heterogênea na extremidade proximal. Encontrou-se hiperplasia epitelial em 20 (69%) extremidades proximais da uretra e uretrite aguda com infiltrado inflamatório misto. Com relação à distribuição de colágeno tipo I e III, diferenças marcantes foram encontradas em todos os grupos. Conclusão: As extremidades supostamente normais da uretroplastia término-terminal apresentam alterações estruturais. A derivação urinária suprapúbica pode influenciar a composição da MEC na uretra bulbar proximal. O valor clínico destes achados, entretanto, necessita maiores investigações. Palavras Chave: Uretra, Estenose uretral, Matriz extracelular, Colágeno, Procedimentos cirúrgicos reconstrutores.